The distal transradial approach (dTRA) may offer certain improvements over a conventional transradial approach (TRA) during coronary interventions, according to new findings published in JACC: Cardiovascular Interventions. However, the study’s authors noted, dTRA was associated with a lower rate of successful sheath insertion and longer procedures.
Researchers evaluated data from more than 1,000 patients who underwent either coronary angiography (CAG) or percutaneous coronary intervention (PCI). While dTRA was used for 518 patients, TRA was used for another 524 patients. All procedures took place at a single hospital in Greece from May 2019 to February 2021.
Overall, the rate of radial artery occlusion (RAO) was 3.7% for the dTRA group and 7.9% for the TRA group.
“Although RAO is usually asymptomatic and not associated with any functional impairment, it hinders the usage of the same radial artery as the access site for future procedures, as a graft for coronary artery bypass graft surgery, or as the site for arteriovenous fistula creation in patients requiring dialysis,” wrote first author Grigorios Tsigkas, MD, an interventional cardiologist at University Hospital of Patras in Greece, and colleagues. “There is a wide variation in the ‘real-world’ reported incidence of RAO (1% to 33%), and numerous strategies to prevent it have been described.”
The dTRA group also required a much shorter median time for hemostasis (60 minutes vs. 120 minutes).
However, the dTRA group was tied to a lower rate of successful sheath insertion (78.7% vs. 94.8%) and the median procedure time (14 minutes vs. 11 minutes).
Future research should focus on “potential approaches” for improving patient outcomes associated with dTRA, the authors concluded.
The full study is available here.
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